Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,025.98 / $4,981.64 / $8,712.62	Facility		$1,025.98	$4,981.64	$8,712.62
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $162.85 / $162.85 / $399.72	Facility	53	$162.85	$162.85	$399.72
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $610.70 / $610.70 / $1,498.94	Facility	54	$610.70	$610.70	$1,498.94
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $122.14 / $122.14 / $299.79	Facility	55	$122.14	$122.14	$299.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $515.95 / $885.47 / $2,811.11	Professional		$515.95	$885.47	$2,811.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $4,329.68 / $4,329.68 / $4,329.68	Professional	50	$4,329.68	$4,329.68	$4,329.68
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $261.50 / $407.14 / $1,326.70	Professional	52	$261.50	$407.14	$1,326.70
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $392.24 / $610.70 / $2,164.85	Professional	54	$392.24	$610.70	$2,164.85
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $9.80 / $96.58 / $398.01	Professional	55	$9.80	$96.58	$398.01
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,740.00 / $3,876.00 / $5,962.00	Facility		$2,740.00	$3,876.00	$5,962.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $626.34 / $1,051.33 / $2,911.76	Professional		$626.34	$1,051.33	$2,911.76
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $939.51 / $1,577.00 / $4,378.78	Professional	50	$939.51	$1,577.00	$4,378.78
CareSource Facility/Professional Facility Modifier Low / Median / High Price $663.96 / $663.96 / $3,084.85	Facility		$663.96	$663.96	$3,084.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $491.82 / $516.41 / $682.44	Professional		$491.82	$516.41	$682.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,439.09 / $1,681.69 / $2,712.50	Facility		$1,439.09	$1,681.69	$2,712.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $675.37 / $1,316.70 / $1,963.06	Professional		$675.37	$1,316.70	$1,963.06
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $522.99 / $814.27 / $2,035.68	Facility		$522.99	$814.27	$2,035.68
Medica Facility/Professional Facility Modifier Low / Median / High Price $727.87 / $3,815.70 / $7,318.00	Facility		$727.87	$3,815.70	$7,318.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $628.07 / $1,374.80 / $6,076.05	Professional		$628.07	$1,374.80	$6,076.05
Medica Facility/Professional Professional Modifier 54 Low / Median / High Price $748.41 / $3,727.68 / $4,353.22	Professional	54	$748.41	$3,727.68	$4,353.22
Medica Facility/Professional Professional Modifier 55 Low / Median / High Price $26.34 / $39.18 / $82.84	Professional	55	$26.34	$39.18	$82.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.42 / $294.91 / $894.60	Professional		$58.42	$294.91	$894.60
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $522.99 / $814.27 / $2,035.68	Facility		$522.99	$814.27	$2,035.68
Quartz Facility/Professional Professional Modifier Low / Median / High Price $967.80 / $1,277.50 / $1,907.05	Professional		$967.80	$1,277.50	$1,907.05
Quartz Facility/Professional Facility Modifier Low / Median / High Price $6,887.55 / $6,887.55 / $6,887.55	Facility		$6,887.55	$6,887.55	$6,887.55
Quartz Facility/Professional Facility Modifier 53 Low / Median / High Price $1,305.69 / $1,305.69 / $1,305.69	Facility	53	$1,305.69	$1,305.69	$1,305.69
Quartz Facility/Professional Facility Modifier 54 Low / Median / High Price $4,569.92 / $4,569.92 / $4,569.92	Facility	54	$4,569.92	$4,569.92	$4,569.92
Quartz Facility/Professional Facility Modifier 55 Low / Median / High Price $979.27 / $979.27 / $979.27	Facility	55	$979.27	$979.27	$979.27
Quartz Facility/Professional Professional Modifier Low / Median / High Price $898.13 / $3,801.00 / $6,076.05	Professional		$898.13	$3,801.00	$6,076.05
Security Health Facility/Professional Professional Modifier Low / Median / High Price $2,830.19 / $7,321.69 / $7,614.56	Professional		$2,830.19	$7,321.69	$7,614.56
United Facility/Professional Facility Modifier Low / Median / High Price $3,353.00 / $6,754.00 / $9,134.00	Facility		$3,353.00	$6,754.00	$9,134.00
United Facility/Professional Professional Modifier Low / Median / High Price $557.58 / $1,162.19 / $2,325.71	Professional		$557.58	$1,162.19	$2,325.71